Incremental versus bulk-fill techniques with thermoviscous composites in Class II restorations: a randomized split-mouth clinical trial.

Authors

C R G Torres, D F da Silva, J C Moreira, M A R de Holanda, P C A Barros, R P Campos, R F A Pinatti, T P Prado, T C Pereira, Ruano R, M C Mailart, A B Borges

Published in

Journal of dentistry. Pages 107166. Nov 12, 2026. Epub Nov 12, 2026.

Abstract

This randomized split-mouth clinical trial evaluated whether placement technique (incremental vs bulk-fill) influences the 2-year clinical performance of Class II restorations using thermoviscous resin composites.
Thirty patients received two class II restorations (N=60) with thermoviscous resin composite, one placed using the incremental technique (VisCalor Universal - Voco) and the other using the bulk-fill technique (VisCalor Bulk - Voco). Both materials were preheated to 68°C using a dedicated infrared heating device. A self-etching adhesive system (Futurabond U - Voco) was used for all restorations. The resin composite used with the incremental technique was placed in 2-mm increments, while the bulk-fill was applied in increments of 4 mm. Restorations were evaluated according to the FDI criteria at 7 days, 1 year, and 2 years postoperatively by two calibrated examiners. Data were analyzed using Fisher's exact test (α=0.05).
After 2 years, 25 patients were available for recall, resulting in the evaluation of 50 restorations. No statistically significant differences were observed between techniques for any of the evaluated parameters (p>0.05). Minor material fractures were detected in two restorations per group and were successfully managed by repair. All restorations were rated as esthetically and biologically acceptable. For the functional scores, 3.33% of restorations in each group were classified as not acceptable regarding fracture and retention. Overall success rates were 95.9% for both techniques.
Both incremental and bulk-fill techniques using thermoviscous resin composites achieved similar results in terms of clinical success after 2 years, with 96.67% of restorations in each group presenting acceptable overall functional scores.
Bulk-fill placement can be considered a viable alternative to incremental techniques in Class II restorations when thermoviscous composites are used, without compromising clinical performance over time.

PMID:
43020454
Bibliographic data and abstract were imported from PubMed on 13 Nov 2026.

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